Overview

Russian men and women face far shorter life expectancies than people in developed countries -- as much as 14 years shorter than their neighbors in Europe. Since 2003, Russian authorities, local institutions, and international partners have worked together to address the social problems and institutional constraints contributing to Russia's poor health profile, yielding significant results, particularly in fighting tuberculosis and HIV/AIDS.

Full Brief—6 Pages
Meeting Health Challenges in the Russian Federation—PDF, April 2010

Challenge

Russian men and women today have a combined life expectancy of 66, about 14 years below the life expectancy of those in the European Union. High mortality and morbidity rates are caused primarily by non-communicable diseases (e.g., heart disease, strokes, cancer) and injuries, mostly from road traffic crashes. These are influenced by the aging of the population, urbanization, changing lifestyles, and risky behaviors, including smoking, alcohol abuse, poor nutrition, and sedentary lifestyles.

At the same time, since the early 1990s, factors including poverty, under-funding of health services, and technical inadequacies have also contributed to Russia having one of the highest rates of tuberculosis (TB) in the world. This has been aggravated by the spread of multi-drug resistant TB and HIV/AIDS.

Approach

Since 2003, the International Bank for Reconstruction and Development (IBRD) has financed two federal-level investment projects in the health sector in Russia. A TB/AIDS Control Project developed policies and guidelines in line with international standards for prevention, diagnosis, treatment and follow-up of patients with TB and HIV, targeting both civilians and prisoners. A health reform project tested new approaches to restructuring the organization of health service delivery, and a third project, in partnership with the International Finance Corporation (IFC), is building capacity to prevent and treat cardiovascular diseases and injuries.

Results

TB mortality in the total population decreased by 15.4 percent from 2006 to 2007, and among prisoners - the most affected group - TB deaths dropped by 37.5 percent. There was also a 72.7 percent increase in TB patients receiving the standardized treatment regimen, including directly observed treatment.

The rate of increase in HIV prevalence dropped by 7.7 percent between 2006 and 2008. HIV-positive infants born to HIV-infected women decreased from 13.6 percent to 9.8 percent between 2004 and 2008.

Health service improvements contributed to decreased infant mortality rates and increased life expectancy of the population (above the average in the country) in the Chuvash Republic and Voronezh Oblast—the pilot regions under the health reform project.

The best way to tell this story is by the results. During the last five years of its implementation the project helped reduce TB prevalence rate by 20 percent and TB mortality rate by 33 percent in the institutions of the Federal Correction Service. By the end of 2008 overall implementation of the TB/AIDS Control Project resulted in increasing coverage of TB patients by bacteriological tests up to 95 percent.  

—Svetlana G. Safonova, Chief, Medical Administration of the Federal Correction Service (Prisons) of the Russian Federation, Doctor of biological sciences

Toward the Future

Russia's Health Reform Implementation Project, initially funded as a 2003-2008 pilot project in Chuvash Republic and Voronezh Oblast, along with support at the federal level, tested new approaches to restructuring health service delivery in the region, for later replication in other regions. This project will continue in Chuvash Republic under a new, $7 million subnational loan provided by IFC and the International Bank for Reconstruction and Development (IBRD). The second phase will focus on building service delivery capacity to address cardiovascular disease and injuries, the leading causes of death and disability in the region.

Additionally, the Bank will continue to provide technical advice to the regional governments on a fee-for-service basis, while sub-national lending will help restructure organization of health service delivery. The use of these new mechanisms is highly relevant to other middle-income countries.

Partners

The World Bank has worked with a number of international partners on health sector improvement in Russia, including the World Health Organization, UNAIDS, Global Fund to Fight AIDS, Tuberculosis and Malaria, Canadian International Development Agency, US Agency for International Development, US Centers for Disease Control and Prevention, International Transport Forum, OECD, U.K Department of Health, Public Health Agency of Canada, Finland National Institute for Health, Bloomberg Initiative to Reduce Tobacco Use, and the Bill and Melinda Gates Foundation.